Clinical Experience of Proximal Radio-Cephalic Fistula

Korean Journal of Nephrology 2011;30(1):35-40.

Seong Cho, Sung Rok Kim and Yu-Ji Lee

Departments of Internal Medicine, Sungkyunkwan University Collage of Medicine, Samsung Changwon Hospital, Changwon, Korea

원저 : 근위부 요골요측피 동정맥루의 임상적 경험

조성, 이유지, 김성록

성균관대학교 의과대학 삼성창원병원 내과

Abstract

Purpose: The first choice of vascular access is a distal radiocephalic fistula (dRCF) at the wrist. In patients with a failed dRCF or with vessels unsuitable for dRCF, the recommendation is to place a brachiocephalic fistula (BC) in the upper arm. Proximal forearm radiocephalic fistulas (pRCF) are created infrequently, but may permit a second forearm fistula before proceeding to the upper arm BC. The goal of the present study was to evaluate the effect of pRCF in hemodialysis patients. Methods: We included 80 patients who received arteriovenous fistula operation between December, 2008 and July, 2010. The type of arteriovenous fistula (dRCF, pRCF, BC) was determined according to preoperative vascular mapping using doppler ultrasonography. The fistula operation was performed by one surgeon. We compared the non-maturation rates, primary and secondary patency rates among dRCF, pRCF, and BC. Results: The numbers of patients that underwent dRCF, pRCF, and BC operation were 27, 27, and 26, respectively. Only 33.8% of patients needed creation of a dRCF potentially. Non-maturation rates were similar among the patients that underwent dRCF, pRCF and BC (11.1%, 7.4%, and 3.8%, respectively, p>0.05). The primary patency rates of dRCF, pRCF, and BC were 81.5%, 92.6%, 80.8%, respectively (p>0.05). The secondary patency rates of dRCF, pRCF, and BC were 92.3%, 96.3%, and 92.3%, respectively (p>0.05). Conclusion: pRCF had non-maturation rate, primary and secondary patency rate, comparable to those of a dRCF and, a BC. pRCF may be an attractive alternative to a BC in patients who do not have vessel suitable for creation of a dRCF.

Key Words: Arteriovenous shunt, Surgical, Radial artery